Near visual acuity and patient-reported outcomes in presbyopic patients after bilateral multifocal aspheric laser in situ keratomileusis excimer laser surgery

Abstract

Purpose: 

To determine improvement of near visual acuity by bilateral multifocal aspheric laser in situ keratomileusis (LASIK) treatments in presbyopic patients.

Setting: 

Goethe-University, Frankfurt, Germany.

Design: 

Prospective, nonrandomized trial.

Methods: 

Thirty presbyopic patients underwent LASIK treatment with a multifocal aspheric ablation profile using an excimer laser (PresbyMAX). The first 15 patients received a multifocal aspheric ablation profile combined with micromonovision. For the consecutive 15 patients, less depth of focus was included on the distance eye (hybrid). Outcome parameters were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected and distance-corrected intermediate visual acuities, uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA); manifest refraction spherical equivalent; subjective quality of vision; and spectacle independence.

Results: 

The data of 29 patients were analyzed and showed that binocular CDVA changed from −0.16 ± 0.10 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.05 ± 0.20 logMAR UDVA and −0.06 ± 0.14 logMAR CDVA (P = .000, P = .001) 1 year postoperatively. Near visual acuity improved from 0.47 ± 0.13 logMAR (DCNVA) and 0.48 ± 0.26 logMAR (UNVA) to 0.19 ± 0.19 logMAR (DCNVA, P < .001) and 0.05 ± 0.15 logMAR (UNVA, P < .001). The hybrid and the μ-monovision group did not differ statistically except for a better DCNVA in the µ-monovision patients (0.21 ± 0.15 logMAR vs 0.34 ± 0.17 logMAR, P = .034). Of the hybrid and µ-monovision patients, 21 (72%) and 12 (41%) had a binocular CDVA and UDVA of 20/20 or better, 8 patients (28%) lost 1 line, 3 (10%) lost 2 lines, 4 (14%) lost 3 lines, and 2 (7%) lost 4 lines of CDVA.

Conclusions: 

The PresbyMAX laser seemed to satisfy most of the patients, although they experienced a loss of CDVA. The gain of near visual acuity and therefore reported less need of spectacles seemed to compensate for this loss.

In Brief

Binocular PresbyLASIK offered an improvement in near visual acuity with consecutive loss of distance visual acuity. Nevertheless, results seemed to satisfy most patients because of reduced spectacle dependency during daily activities.